Gulati Sheffali, Jain Puneet, Sachan Deepak, Chakrabarty Biswaroop, Kumar Atin, Pandey R M, Gupta Arun K
Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Epilepsy Res. 2014 Sep;108(7):1212-20. doi: 10.1016/j.eplepsyres.2014.04.013. Epub 2014 May 14.
Neurocysticercosis, parasitic infestation of the central nervous system by the Taenia solium larvae, is a major public health problem, primarily in the developing countries. Seizures are the primary clinical manifestation which could be acute (secondary to active lesions) or remote symptomatic (due to calcified lesions). Cysticidal therapy is the standard of care for solitary parenchymal active neurocysticerci. However treatment related side effects and tendency to spontaneous resolution raises concern from time to time whether cysticidal therapy is actually required. This is a retrospective case record analysis of two groups of patients with solitary parenchymal neurocysticerci (group A; 171 patients between 2000 and 2004 who did not receive cysticidal therapy, group B; 512 patients between 2008 and 2013 who received cysticidal therapy). Group B had significantly more radiological resolution of lesions whereas group A reported significantly more seizure recurrences on antiepileptics. There was no significant difference in occurrence of calcification in the two groups. Overall patients with calcified lesions had significantly more breakthrough seizures. Well designed prospective studies should be planned in future to understand the mechanism underlying the epileptogenicity of calcified lesions and how they are linked to host and environment factors.
神经囊尾蚴病是由猪带绦虫幼虫引起的中枢神经系统寄生虫感染,是一个主要的公共卫生问题,主要发生在发展中国家。癫痫发作是主要的临床表现,可能是急性的(继发于活动性病变)或远隔症状性的(由于钙化病变)。囊虫icidal疗法是孤立性实质活动性神经囊尾蚴病的标准治疗方法。然而,与治疗相关的副作用和自发缓解的倾向不时引发人们对是否真的需要囊虫icidal疗法的担忧。这是对两组孤立性实质神经囊尾蚴病患者的回顾性病例记录分析(A组;2000年至2004年间171例未接受囊虫icidal疗法的患者,B组;2008年至2013年间512例接受囊虫icidal疗法的患者)。B组病变的影像学消退明显更多,而A组报告在使用抗癫痫药物时癫痫复发明显更多。两组钙化的发生率没有显著差异。总体而言,有钙化病变的患者突破性癫痫发作明显更多。未来应计划进行精心设计的前瞻性研究,以了解钙化病变致痫性的潜在机制以及它们如何与宿主和环境因素相关联。